Urban–Rural Medical Insurance Integration and Out-of-pocket Medical Expenditures

Abstract

This paper empirically evaluates the impact of China’s 2016 urban–rural medical insurance integration on rural residents’ out-of-pocket medical expenditures using panel data from Hebei Province in the China Family Panel Studies for 2014 and 2018, with a difference-in-differences approach. The findings reveal three main results. First, the integration reform did not produce a statistically significant reduction in rural residents’ out-of-pocket medical expenditures. Second, age emerges as a significant predictor of out-of-pocket medical spending, while gender and household income show no statistically meaningful effects. Third, heterogeneity analysis indicates that the policy exhibits a larger coefficient for the elderly group, though it does not reach conventional significance levels. These findings suggest that simply merging administrative insurance schemes, without complementary measures addressing supply-side cost control and demand-side behavioral responses, may be insufficient to reduce the actual financial burden on rural populations.